Immune abnormalities associated with chronic mucocutaneous candidiasis

Twenty six patients with chronic mucocutaneous candidiasis (CMCC) have been studied. Four immunological patterns emerged.Five patients failed to produce migration inhibitory factor (MIF) in vitro although their lymphocytes were normally activated to DNA synthesis after challenge with candida antigen. Four of these patients were unable to mount delayed hypersensitivity (DH) reactions to candida antigen (CAg), purified protein derivative (PPD), or dinitrochlorobenzene (DNCB). The lack of DH in these patients is thought to reflect their inability to produce MIF.Another group of nine patients with absent DH to candida also failed to produce MIF after challenge with candida antigen. Their lymphocytes were, however, not activated in vitro by this antigen probably due to a factor present in their serum, which specifically inhibited candida induced transformation of lymphocytes from healthy individuals.Two patients were able to produce MIF in vitro but they were unable, nevertheless, to mount DH reactions. Furthermore, they did not show delayed inflammatory response to intradermal injections of a MIF preparation. It is postulated that these patients have defective macrophage function.In 10 patients no significant abnormalities in cellular or humoral immunity were revealed.It is concluded that chronic mucocutaneous candidiasis is a syndrome associated with several distinct immunological abnormalities. The pathogenesis of the syndrome is discussed and it is emphasized that chronic mucocutaneous candidiasis is a model which can be used for advancing our knowledge of the immune system.